Healthfirst
Care Manager - Bilingual Spanish/English 100 % Remote
Healthfirst, Nashville, Tennessee, United States
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Care Manager - Bilingual Spanish/English 100% Remote
role at
Healthfirst .
The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and healthcare team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. They are assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.
Duties and Responsibilities
Advocate, inform, and educate beneficiaries on services, self‑management techniques, and health benefits.
Conduct assessments to identify barriers and opportunities for intervention.
Develop care plans that align with the physician’s treatment plans and recommend interventions that align with proposed goals.
Generate referrals to providers, community‑based resources, and appropriate services to assist in goal achievement and maintenance of successful health outcomes.
Liaise between service providers such as doctors, social workers, discharge planners, and community‑based service providers to ensure care is coordinated and care needs are adequately addressed.
Coordinate and facilitate with the multi‑disciplinary healthcare team as necessary to ensure care plan goals and treatment is person‑centered and maximizes member health outcomes.
Assist in identifying opportunities for alternative care options based on member needs and assessments.
Evaluate service authorizations to ensure alignment and execution of the member’s care and physician treatment plan.
Contribute to corporate goals through ongoing execution of member care plans and member goal achievement.
Document all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follow up as needed; and update care plans based on member needs.
Occasional overtime as necessary.
Other duties as assigned.
Minimum Qualifications
For Medical Care Management:
Licensed Professional: NYS RN or LCSW/LMSW (any state)
PEDS positions: 1 year of pediatric clinical field experience and/or experience with families and child‑serving systems, including child welfare and/or medically fragile/developmentally disabled populations
For Behavioral Health (BH) Care Management:
Licensed Professional: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
3 years of work experience in a mental/behavioral health or addictions setting
BH PEDS positions: 1 year of pediatric clinical field experience and/or experience with families and child‑serving systems, including child welfare and/or medically fragile/developmentally disabled populations
Must be fluent in Spanish
Strong interpersonal and assessment skills, especially ability to relate well with seniors, their families, and community care providers, with demonstrated ability to handle rapidly changing situations.
Knowledge and experience with current community health practices for frail adult population and cognitive‑impaired seniors.
Experience managing member information in a shared network environment using paperless database modules and archival systems.
Experience and knowledge of relevant product lines.
Relevant work experience preferably as a Care Manager.
Demonstrated ability to manage large caseloads and work effectively in a fast‑paced environment.
Proficient with simultaneously navigating the internet and multi‑tasking with multiple electronic documentation systems.
Experience using Microsoft Excel with ability to edit, search, sort‑filter, and other Microsoft and PHI systems.
Hiring Range
Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $108,160
Benefits Healthfirst offers employees a full range of benefits such as medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). The company provides a competitive compensation and benefits package wherever employees work and live.
Job Details
Seniority level: Not Applicable
Employment type: Full‑time
Job function: Health Care Provider
Industries: Hospitals and Health Care
Location: 100% Remote
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Care Manager - Bilingual Spanish/English 100% Remote
role at
Healthfirst .
The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and healthcare team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. They are assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.
Duties and Responsibilities
Advocate, inform, and educate beneficiaries on services, self‑management techniques, and health benefits.
Conduct assessments to identify barriers and opportunities for intervention.
Develop care plans that align with the physician’s treatment plans and recommend interventions that align with proposed goals.
Generate referrals to providers, community‑based resources, and appropriate services to assist in goal achievement and maintenance of successful health outcomes.
Liaise between service providers such as doctors, social workers, discharge planners, and community‑based service providers to ensure care is coordinated and care needs are adequately addressed.
Coordinate and facilitate with the multi‑disciplinary healthcare team as necessary to ensure care plan goals and treatment is person‑centered and maximizes member health outcomes.
Assist in identifying opportunities for alternative care options based on member needs and assessments.
Evaluate service authorizations to ensure alignment and execution of the member’s care and physician treatment plan.
Contribute to corporate goals through ongoing execution of member care plans and member goal achievement.
Document all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follow up as needed; and update care plans based on member needs.
Occasional overtime as necessary.
Other duties as assigned.
Minimum Qualifications
For Medical Care Management:
Licensed Professional: NYS RN or LCSW/LMSW (any state)
PEDS positions: 1 year of pediatric clinical field experience and/or experience with families and child‑serving systems, including child welfare and/or medically fragile/developmentally disabled populations
For Behavioral Health (BH) Care Management:
Licensed Professional: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
3 years of work experience in a mental/behavioral health or addictions setting
BH PEDS positions: 1 year of pediatric clinical field experience and/or experience with families and child‑serving systems, including child welfare and/or medically fragile/developmentally disabled populations
Must be fluent in Spanish
Strong interpersonal and assessment skills, especially ability to relate well with seniors, their families, and community care providers, with demonstrated ability to handle rapidly changing situations.
Knowledge and experience with current community health practices for frail adult population and cognitive‑impaired seniors.
Experience managing member information in a shared network environment using paperless database modules and archival systems.
Experience and knowledge of relevant product lines.
Relevant work experience preferably as a Care Manager.
Demonstrated ability to manage large caseloads and work effectively in a fast‑paced environment.
Proficient with simultaneously navigating the internet and multi‑tasking with multiple electronic documentation systems.
Experience using Microsoft Excel with ability to edit, search, sort‑filter, and other Microsoft and PHI systems.
Hiring Range
Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $108,160
Benefits Healthfirst offers employees a full range of benefits such as medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). The company provides a competitive compensation and benefits package wherever employees work and live.
Job Details
Seniority level: Not Applicable
Employment type: Full‑time
Job function: Health Care Provider
Industries: Hospitals and Health Care
Location: 100% Remote
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